Pain associated with fibromyalgia interferes with daily function, work, and social activities resulting in a decreased quality of life. People with fibromyalgia also have a significant amount of fatigue and a fear of movement. People with fibromyalgia show enhanced excitability of pain neurons in the central nervous system and reduced pain inhibition. Therefore, one of the main treatments for patients with fibromyalgia must focus on pain relief to allow the person to function more independently both at home and at work. Transcutaneous electrical nerve stimulation is used by health professionals to deliver electrical stimulation through the skin for pain control. Basic science studies, from the PI's laboratory show that TENS activates descending pain inhibitory pathways to inhibit excitability of pain neurons. Thus the ideal patient population for the treatment of TENS would be one in which there is enhanced central excitability and reduced inhibition; fibromyalgia is such a condition.

Hypothesis: The investigators hypothesize that application of Transcutaneous Electrical Nerve Stimulation (TENS) to patients with fibromyalgia will reduce resting and movement-related pain and reduce central excitability by restoring diffuse noxious inhibitory controls (DNIC), and that this decrease in pain and/or central excitability will reduce fatigue and fear of movement, thereby improving function and quality of life

The primary aim of the study is to test the effect of the long-term use of TENS on movement-related pain as measured by a numeric rating scale (NRS) during six minute walk test (6MWT) in women with fibromyalgia with random assignment to three treatments: standard care (No TENS), placebo TENS and active TENS.

Secondary Outcome Measures:

Aim #2: Function and quality of life [ Time Frame: Change from from baseline to session 4: 9 weeks ] [ Designated as safety issue: No ]

A secondary aim will test if movement-pain reduction by TENS results in a concomitant decrease in fear of movement, fatigue, resting pain and analgesic medication and an increase in function and quality of life. Outcome measures will include physical function by directly assessing daily activity with an accelerometer, self-report (IPAQ), as well as performing specific function tasks. A sub-analysis will determine responders and non-responders to TENS and factors that predict both responders and non-responders. Multiple factors that could contribute to TENS response include self-efficacy, pain catastrophizing, levels of physical activity, fear of movement, sleep, pain, fatigue, function, quality of life, or pain physiology.

PROMIS (National Institute of Health's patient reported outcome measurement information system) results will be compared to other validated patient outcomes to determine if PROMIS is a useful instrument to describe the experience of women with fibromyalgia.

This group will receive placebo TENS for the first 4 weeks of the study and then active TENS for the last four weeks of the study.

Device: TENS

TENS Parameters: Active TENS and Placebo TENS

TENS Frequency - 10 to100 Hz

TENS Pulse Width - 200 µs

TENS Intensity - Maximal tolerable intensity

Duration: 2 hours per day. The 2 hours may be broken into smaller segments of time with a minimum of 30 minutes.

Administration - Daily

TENS Location: TENS electrode on the skin will be a 4 x 7 butterfly electrode to the cervical and lumbar region.

Placebo TENS Unit Active TENS unit Stand Care - no TENS

Other Name: Empi Select Unit

No Intervention: Standard Care

Subjects will not receive TENS intervention during the first 4 weeks of the trial but will complete all testing procedures as the other two arms. This group will receive active TENS during the last 4 weeks of the study.

Active Comparator: Active TENS

Active TENS for 4 weeks of the study and will add an additional 4 weeks of active TENS for the last 4 weeks of the study.

Device: TENS

TENS Parameters: Active TENS and Placebo TENS

TENS Frequency - 10 to100 Hz

TENS Pulse Width - 200 µs

TENS Intensity - Maximal tolerable intensity

Duration: 2 hours per day. The 2 hours may be broken into smaller segments of time with a minimum of 30 minutes.

Administration - Daily

TENS Location: TENS electrode on the skin will be a 4 x 7 butterfly electrode to the cervical and lumbar region.

Placebo TENS Unit Active TENS unit Stand Care - no TENS

Other Name: Empi Select Unit

Detailed Description:

This is a phase II randomized, double-blind, placebo controlled multi-center clinical trial involving a device, Transcutaneous Electrical Nerve Stimulation (TENS). TENS is a non-pharmacological agent which delivers electrical stimulation by a battery operated device via electrodes placed on the skin. TENS is considered to be a safe, inexpensive and non-invasive modality used to treat a variety of acute and chronic pain conditions. The initial phase of the study will randomly allocate subjects to receive active TENS, placebo TENS or standard care (No TENS). After participating in the 1 month random assignment, all subjects will receive active TENS for 1 month. The subjects will make 4 visits to the clinic approximately 2 to 3 1/2 hours each visit. Visits will entail questionnaires, functional tasks, accelerometry, TENS, pain and fatigue assessments.

Study Aims:

Aim #1: The primary aim of the study is to test the effect of the long-term use of TENS on movement-related pain as measured by a numeric rating scale (NRS) during six minute walk test (6MWT) in women with fibromyalgia with random assignment to three treatments: standard care (No TENS), placebo TENS and active TENS.

Aim #2: A secondary aim will test if movement-pain reduction by TENS results in a concomitant decrease in fear of movement, fatigue, resting pain and analgesic medication and an increase in function and quality of life. Outcome measures will include physical function by directly assessing daily activity with an accelerometer, self-report (IPAQ), as well as performing specific function tasks. A sub-analysis will determine responders and non-responders to TENS and factors that predict both responders and non-responders. Multiple factors that could contribute to TENS response include self-efficacy, pain catastrophizing, levels of physical activity, fear of movement, sleep, pain, fatigue, function, quality of life, or pain physiology.

Aim #3: To determine if active TENS alters pain processing in women with fibromyalgia and if improvement in clinical symptoms correlates with normalization of pain processing physiology. We will evaluate change in these physiologic parameters in responders versus non-responders as assessed clinically.Pain processing will be assessed by examining pressure pain thresholds at the site and outside the site of stimulation and by examining conditioned pain modulation

Aim #4: To determine if PROMIS (patient reported outcome measurement information system) is a useful instrument for assessing outcomes in women with fibromyalgia by comparing the PROMIS modules to symptom domains measured by other instruments validated for use in fibromyalgia clinical trials and by determining the performance of PROMIS in the definition of responders.

Eligibility

Ages Eligible for Study:

18 Years to 70 Years

Genders Eligible for Study:

Female

Accepts Healthy Volunteers:

No

Criteria

Inclusion Criteria:

Participants will be 18 to 70 years of age

Women may participate in the study, with the understanding that within the clinical population of fibromyalgia the there is a 7:1 ratio of female to male.

Diagnosis of Fibromyalgia by 1990 ACR criteria (11/18 tender points)

History of cervical or lumbar pain with fibromyalgia (this is expected in all patients since axial pain is required for diagnosis)

Current stable treatment regimen for the last 4 weeks and projected stable treatment regimen for the next 2 months.

English speaking

Exclusion Criteria:

Current or history of cardiovascular, pulmonary, neurological, endocrine, or renal disease that would preclude the involvement in the study.

Change in or new drug or treatment program within the last month or in the next 2months, i.e. must have a stable treatment plan

Unstable medical or psychiatric condition which in the opinion of the investigator could compromise the subject's welfare or confound the study results

Contacts and Locations

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Please refer to this study by its ClinicalTrials.gov identifier: NCT01888640